Healthcare Provider Details

I. General information

NPI: 1710041983
Provider Name (Legal Business Name): GAYE NICOLE HAYNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 FRANKLIN PKWY
FRANKLIN GA
30217-7544
US

IV. Provider business mailing address

119 AMBULANCE DR 202
CARROLLTON GA
30117-3857
US

V. Phone/Fax

Practice location:
  • Phone: 706-675-6949
  • Fax: 706-675-1962
Mailing address:
  • Phone: 770-838-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number049696
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: